HIV-AIDS-Case-Management

Members with HIV typically require assistance with coordination of services related to work, home life, medical and mental health care, legal issues, and finances. The HIV Case Management program provides assistance with finding community resources and navigating the medical system.

Our Complex Case Management department offers an HIV Case Management program to help patients with HIV identify and obtain care, learn about disease process and management, adhere to complex medication schedules and find community resources.

Our specially trained HIV case managers provide confidential disease-focused assessments, interventions and monitoring to help patients with HIV maximize their health and wellness outcomes. They work with patients to break through barriers to effective care and to navigate and access health services. Case managers advocate for and liaise between our members and their families, caregivers and clinicians in a HIPAA-compliant manner

Program Goals

• Empower members to assume responsibility for their own health care
• Educate members about the availability of anonymous and rapid testing on an ongoing basis
• Educate members about New York State Public Health Law (Article 27-F), which specifically discusses confidentiality of HIV/AIDS personal health information
• Encourage providers to refer members to Designated AIDS Centers (DACs)
• Whenever possible, HIV specialists will be designated as the primary care physician per plan policy
• Enable members to make informed decisions
• Ensure appropriate utilization of resources, including returning to Fee-for-Service Medicaid, when appropriate. Some areas (Brooklyn, Bronx, Manhattan, Queens, and Staten Island) within New York State have started mandatory enrollment for this population.
• Educate members about the transmission of HIV/AIDS and compliance with universal precautions
• Educate members about proper use of medications including dose schedule and side effects
• Educate members about the importance of proper follow-up care including information about appropriate health care coverage for medical and pharmacy needs, (i.e., ADAP, SNPs, Medicaid)
• Preparation for end-of life-care, if appropriate (refer to Dignified Decisions for hospice referral)

HIV Care Guidelines: The Basics

Members living with HIV should have a minimum of:

• Two outpatient care visits per year (one in each half of the year)
• Two viral load tests per year (one in each half of the year)
• Yearly screening for syphilis
• Monitored antiretroviral medication adherence

In the context of a trusting, confidential relationship, HIV case managers help members overcome financial, psychosocial and functional barriers to achieving care standards and adherence. For more information, please consult our clinical practice guidelines for HIV/AIDS management, adopted from recognized sources.

Additional HIV/AIDS resources are available for your patients.

To refer a patient to the EmblemHealth HIV Case Management program, please call or have the member call 1-800-447-0768.